27 [chapter 27 fluid, electrolyte and acid base homeostasis]
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Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.
CHAPTER 27Fluid, Electrolyte, and Acid–Base
Homeostasis
Principles of Anatomy and Physiology
14th Edition
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In adults, body fluids make up between 55% and 65% of total body mass.
Body fluids are present in two main compartments—inside cells (2/3) and outside cells (1/3).
Intracellular fluids is cytosol. Extracellular fluid is interstitial fluid
(80%) and blood plasma (20%)
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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The plasma membrane of cells separates intracellular fluid from interstitial fluid.
Blood vessel walls divide the interstitial fluid from blood plasma.
Capillary walls are thin enough to allow exchange of water and solutes between blood plasma and interstitial fluid.
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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Filtration, reabsorption, diffusion and osmosis allow continuous exchange of water and solutes among body fluid compartments.
The balance of inorganic compounds that dissociate into ions (electrolytes) is closely related to fluid balance.
The body gains water by ingestion and metabolic synthesis.
The body loses water via urination, perspiration, exhalation and in feces.
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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The level of aerobic respiration determines the volume of metabolic water formed. The amount of water formed is directly proportional to the amount of ATP produced.
When water loss is greater than water gain, dehydration occurs leading to increased thirst.
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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Elimination of excess body water occurs through urine production.
The amount of urinary salt loss is the main factor determining body fluid volume.
The two main solutes in urine are sodium ions (Na+) and chloride ions (Cl–).
Wherever solutes go, water follows.
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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3 major hormones control renal Na+ and Cl–:1. Angiotensin II
2. Aldosterone
3. Atrial natriuretic peptide (ANP)
The major hormone that regulates water loss is antidiuretic hormone (ADH)
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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Water intoxication occurs when excess body water causes cells to swell dangerously.
This may occur when a person consumes water faster than the kidneys can excrete it.
Fluid Compartments and Fluid Homeostasis
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Fluid Compartments and Fluid Homeostasis
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Ions formed when electrolytes dissociate and dissolve: Control osmosis of water between fluid
compartments
Help maintain the acid-base balance
Carry electrical current
Serve as cofactors
Electrolytes in Body Fluids
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The concentration of ions is expressed in units of milliequivalents per liter (mEq/liter).
Blood plasma, interstitial fluid and intracellular fluid have different concentrations of electrolytes and protein ions.
Blood plasma contains many protein ions and interstitial fluid contains only a few.
Electrolytes in Body Fluids
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Electrolytes in Body Fluids
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Sodium: most abundant ions in extracellular fluid Used for impulse transmission, muscle contraction, fluid and
electrolyte balance.
It’s level is controlled by aldosterone, ADH and ANP
Chloride: the major extracellular ion Helps regulate osmotic pressure between compartments
Forms HCl in the stomach
Regulation of Cl– balance is controlled by aldosterone
Electrolytes in Body Fluids
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Potassium: most abundant cation in extracellular
fluid Involved in fluid volume, impulse conduction, muscle
contraction and regulating pH
Mineralocorticoids (mainly aldosterone) regulate the
plasma level
Bicarbonate: important plasma ion Major member of the plasma acid-base buffer system
Kidneys reabsorb or secrete it for final acid-base balance
Electrolytes in Body Fluids
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Calcium: most abundant ion in the body Structural component of bones and teeth
Used for blood coagulation, neurotransmitter release, muscle tone, excitability of nerves and muscles
Level in plasma regulated by parathyroid hormone
Phosphate: occurs as calcium phosphate salt
Used in the buffer system
Regulated by parathyroid hormone and calcitriol
Electrolytes in Body Fluids
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Magnesium: an intracellular cation Activates enzymes involved in carbohydrate and
protein metabolism
Used in myocardial function, transmission in the CNS and operation of the sodium pump
Electrolytes in Body Fluids
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Electrolytes in Body Fluids
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Electrolytes in Body Fluids
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The pH of arterial blood ranges from 7.35 to 7.45. Several mechanisms maintain this range.
Buffer systems
Exhalation of carbon dioxide
Kidney excretion of H+
Acid–Base Balance
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Buffer systems include: Protein buffer system: most abundant in
intracellular fluid and blood plasma. When pH rises, the COOH group dissociates to act like an acid.
Acid–Base Balance
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When pH falls, the free amino group dissociates to act like a base.
Acid–Base Balance
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Hemoglobin in red blood cells acts as a buffer:
Acid–Base Balance
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Carbonic acid-bicarbonate buffer system: this is based on the bicarbonate ion (HCO3–) which acts as a weak base, and carbonic acid (H2CO3) which acts as a weak acid.
If the pH falls, the HCO3– removes excess H+:
Acid–Base Balance
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If the pH rises, H2CO3 can provide H+:
Acid–Base Balance
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Phosphate buffer system: this system acts similarly to the carbonic acid-bicarbonate buffer system. Dihydrogen phosphate (H2PO4–) and monohydrogen phosphate (HPO42–) are the ions used in this system. H2PO4– acts as a weak acid:
Acid–Base Balance
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HPO42– acts as a weak base:
Acid–Base Balance
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Exhalation of carbon dioxide: CO2 mixes with water in the blood to form carbonic acid (H2CO3). Exhaling CO2 leads to less acid production and a rise in pH. Retaining CO2 leads to more acid production and a drop in pH.
Acid–Base Balance
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Acid–Base Balance
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Kidney excretion of H+: Excreting H+ in the urine removes nonvolatile acids. The proximal convoluted tubules and collecting ducts of the kidneys secrete H+ into the tubular fluid.
Acid–Base Balance
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Acid–Base Balance
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Some H+ secreted into the tubular fluid of the collecting duct is buffered by HPO42– and NH3. The buffers are excreted in the urine.
Acid–Base Balance
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Acid–Base Balance
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Acid-base imbalances may occur.
Acidosis: blood pH is below 7.35
Alkalosis: blood pH is above 7.45
Respiratory acidosis: blood pH drops due to excessive
retention of CO2 leading to excess H2CO3.
Respiratory alkalosis: blood pH rises due to excessive loss of
CO2 as in hyperventilation.
Metabolic acidosis: arterial blood levels of HCO3– falls.
Metabolic alkalosis: arterial blood levels of HCO3– rises.
Acid–Base Balance
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Acid–Base Balance
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Acid–Base Balance
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Regulation of pH
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Significant differences exist between adults and infants in
respect to fluid distribution, regulation of fluid and
electrolyte balance and acid-base homeostasis.
Differences exist due to: proportion and distribution of
water
Metabolic rate
Functional development of the kidneys
Body surface area
Breathing rate
Ion concentrations
Aging and Fluid, Electrolyte, and Acid-Base Homeostasis
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Older adults often have impaired ability to maintain fluid, electrolyte and acid-base balance. Basically, all systems slow down and function less efficiently.
Older adults often suffer with: dehydration and hypernatremia – inadequate fluid intake, loss of more water than Na+
Hypokalemia – chronic use of laxatives, drugs that cause K+ loss
Aging and Fluid, Electrolyte, and Acid-Base Homeostasis
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Acidosis – impaired ability of lungs and kidneys to compensate for acid-base imbalances.
Aging and Fluid, Electrolyte, and Acid-Base Homeostasis
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End of Chapter 27
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